Read Your Certificate Carefully

Transcription

1 Group Term Life Certificate of Insurance Minnesota Life Insurance Company - A Securian Company 400 Robert Street North St. Paul, Minnesota POLICYHOLDER: University of Notre Dame Du Lac POLICY NUMBER: G Full-time or visiting faculty, administrators, staff employees, interns, research associates and eligible retirees Read Your Certificate Carefully You are insured under the group policy shown on the specifications page attached to this certificate. This certificate summarizes the principal provisions of the group policy that affect you. The provisions summarized in this certificate are subject in every respect to the group policy. You may examine the group policy at the principal office of the policyholder during regular working hours. Right to Cancel It is important to us that you are satisfied with this certificate after it is issued. If you are not satisfied with this certificate, you may cancel it by delivering or mailing a written notice or sending a telegram to Minnesota Life Insurance Company (Minnesota Life), 400 Robert Street North, St. Paul, Minnesota and returning the certificate before midnight of the 30th day after you received this certificate. Notice given by mail and return of the certificate by mail are effective on being postmarked, properly addressed, and postage prepaid. If you return this certificate, you will receive, within 10 days of the date we receive a notice of cancellation, a full refund of any premiums you have paid. Upon cancellation of this certificate, it will be void as if it had never been issued. Secretary President TABLE OF CONTENTS Definitions... 2 General Information... 2 Premiums... 3 Death Benefit... 4 Termination... 4 Conversion Right... 5 Additional Information... 6 GROUP TERM LIFE CERTIFICATE OF INSURANCE MHC Minnesota Life 1 Ed. F Rev

2 CERTIFICATE SPECIFICATIONS PAGE GENERAL INFORMATION POLICYHOLDER: University of Notre Dame Du Lac POLICY NO.: G ASSOCIATED COMPANIES: POLICY EFFECTIVE DATE: Congregation of Holy Cross, Indiana Province January 1, This specifications page represents the plan in effect as of January 1, This certificate and/or certificate specifications page replaces any and all certificates and/or certificate specifications pages previously issued to you under the group policy. Please replace any certificate and/or certificate specifications page previously issued to you with this new certificate and/or specifications page. GROUP: ENROLLMENT PERIOD: The group is composed of all full-time regular or visiting faculty, administrators, staff employees, interns, research associates, and eligible retirees of the policyholder. Not applicable for noncontributory insurance; 31 days from the first day of eligibility for contributory insurance. WAITING PERIOD: For employees in an eligible class on January 1, 2003: None MINIMUM HOURS PER WEEK REQUIRED: PLAN OF INSURANCE EMPLOYEE TERM LIFE INSURANCE: Basic Insurance For all other employees: The period, if any, commencing with the employee's date of employment and ending with the first day of the month next following or coinciding with the employee's date of employment. 30 hours per week for employees on a 12-month work schedule; 40 hours per week for full-time employees on a nine month work schedule. EMPLOYEE BENEFIT SCHEDULE Eligible Class Amount of Insurance All active employees $25,000 Supplemental Insurance An employee may elect an amount of supplemental insurance from the following options: Eligible Class All active employees Amount of Insurance One to 10 times annual earnings, rounded to the next higher $1,000 if not already a multiple thereof, subject to a maximum amount of supplemental insurance of $1,500,000. F.MHC A

3 GENERAL PROVISIONS FOR EMPLOYEE INSURANCE AGE REDUCTIONS: For employees who are age 65 or older on January 1, 2002: The maximum amount of basic and supplemental life insurance available to an employee age 65 or older shall be reduced to the increment and amount specified below, rounded to the next higher $1,000 if not already a multiple thereof: Age of Employee For employees who attain age 65 after January 1, 2002: Maximum Amount of Insurance Seven times annual earnings, subject to a maximum of $725,000 Six times annual earnings, subject to a maximum of $625,000 The amount of supplemental life insurance on an employee age 65 or older shall be a percentage of the amount otherwise provided by the plan of insurance applicable to such employee in accordance with the following table: Age of Employee and over Amount of Insurance as a Percentage of Amount Prior to Attaining Age 65 65% 50% 25% Age reductions will apply the January 1 next following an insured employee s attainment of the age specified above. RETIREMENT REDUCTIONS: An employee is eligible for continued coverage as a retiree if he or she: 1. has attained the age of 55 or older; and 2. has worked for the policyholder for at least five years of continuous service at the time of retirement; and 3. was insured under the group policy immediately prior to retiring. An employee who retires earlier than 1 or 2 above may also be eligible for continued coverage as a retiree if he or she: 1. retired earlier than 1 or 2 above due to disability; and 2. does not return to active work for the policyholder in any class of employees eligible for insurance under the group policy; 3. was insured under the group policy immediately prior to becoming disabled. An employee s amount of retiree insurance is as follows: For employees who retire during or after 1981 Basic coverage for all employees terminates upon retirement. An eligible retiree may elect to continue supplemental coverage under either option 1 or option 2 below: Option 1: $2,500 Option 2: $5,000 F.MHC B

4 RETIREMENT REDUCTIONS (Continued): For employees who retired prior to 1981 The amount of retiree insurance shall be determined according to the employee s annual wage immediately prior to retirement as follows: Annual Wage Retiree Insurance Less than $5,000 $1,000 $5,000, but less than $10,000 $2,000 $10,000, but less than $15,000 $3,000 $15,000 or more $4,000 A retired faculty employee who returns to active work for the policyholder shall not be eligible for the retiree benefit while eligible for coverage as an active employee under the group policy. However, when the employee ceases active work for the policyholder and is no longer eligible for coverage as an active employee, the employee s full amount of retiree insurance inforce immediately prior to the employee s return to active status shall be reinstated. CONTRIBUTORY/NONCONTRIBUTORY: GUARANTEED ISSUE AMOUNT: Basic insurance is noncontributory insurance; supplemental and retiree insurance is contributory insurance. Guaranteed issue is the amount of insurance an employee can receive without evidence of insurability when first eligible under the plan provided enrollment is made within the enrollment period. The amounts are as follows: For basic insurance: All basic insurance is guaranteed issue. For supplemental insurance: For employees in an eligible class on January 1, 2003: An amount equal to the amount of contributory insurance for which the employee was insured under the prior carrier s group policy on December 31, For all other employees: Three times annual earnings. EVIDENCE OF INSURABILITY: EFFECTIVE DATE OF INCREASES AND DECREASES DUE TO CHANGE IN ELIGIBLE CLASS OR EARNINGS: Evidence of insurability is required as stated in the certificate and for an amount of insurance greater than the guaranteed issue amount. Increases or decreases in an employee s amount of insurance due to a change in earnings shall become effective the January 1 next following the date of change. All increases are subject to the actively at work requirement. DEPENDENTS TERM LIFE INSURANCE An amount elected by the employee from the following options: DEPENDENTS BENEFIT SCHEDULE Eligible Class Spouse Children Amount of Life Insurance $12,500 or $25,000 $5,000 or $10,000 An employee may choose to elect coverage for his or her spouse-only, child(ren)-only or both spouse and child(ren). F.MHC C

5 GENERAL PROVISIONS FOR DEPENDENTS INSURANCE CONTRIBUTORY/NONCONTRIBUTORY: GUARANTEED ISSUE AMOUNT: Dependents insurance is contributory insurance. Guaranteed issue is the amount of insurance an eligible dependent can receive without evidence of insurability when first eligible under the plan provided enrollment is made within the enrollment period. The amounts are as follows: For employees with eligible dependents on January 1, 2003: During the one-time open enrollment period (November 4, 2002 to December 31, 2002), all dependent child insurance is guaranteed issue. For dependents who first become eligible on or after January 1, 2003 but before January 1, 2007: Spouse: $12,500 Child(ren): $4,000 For dependents who first become eligible on or after January 1, 2007 but before January 1, 2009: Spouse: $12,500 Child(ren): $5,000 For dependents who first become eligible on or after January 1, 2009: Spouse: $25,000 Child(ren): $10,000 EFFECT OF EMPLOYEE S RETIREMENT: EXTENDED DEATH BENEFIT FOR INSURED DEPENDENTS: EVIDENCE OF INSURABILITY: All dependents insurance terminates upon the employee s retirement. Notwithstanding anything in the policy to the contrary, in the event of the employee s death while covered under the group policy, dependents insurance will be extended for six months from the employee s date of death, without further payment of premium. Evidence of insurability is required as stated in the certificate and for an amount of insurance greater than the guaranteed issue amount. ADDITIONAL INFORMATION SUICIDE EXCLUSION FOR LIFE INSURANCE: Applies only to employee supplemental life insurance effective on or after January 1, 2003, or any requested increase in insurance effective after such date. ANNUAL ENROLLMENT: During the employer s annual open enrollment, the following election changes can be made without providing evidence of insurability: An employee may increase existing supplemental life insurance by one times annual earnings, provided the resulting amount of insurance does not exceed $750,000. An employee may elect any child life amount, provided the child receiving the increase has not previously been declined any insurance amount by us under the group policy due to evidence of insurability being found unsatisfactory. Coverage will be effective on the January 1 following the annual enrollment. This offer is subject to the actively at work requirement for employees. F.MHC D

6 LIFE OR FAMILY STATUS CHANGE: An employee who experiences one of the Family Status Changes listed below may make the following election changes without providing evidence of insurability, provided enrollment is made within 31 days of the status change and the insured receiving the increase has not previously been declined any insurance amount by us under the group policy due to evidence of insurability being found unsatisfactory: An employee may elect for the first time or increase existing supplemental life insurance by one times annual earnings, provided the resulting amount of insurance does not exceed $750,000. An employee may elect for the first time or increase existing spouse life insurance by one level. An employee may elect for the first time or increase existing child life insurance by one level. Benefit elections made during the annual enrollment period are for the entire plan year (January 1 to December 31), unless an employee experiences a change in life or family status qualifying the employee to make changes in benefit selections at a time other than an annual enrollment period. Coverage will be effective on the date of the election, subject to the actively at work requirement for employees. Family Status Change for this purpose means: change in marital status; or death of your spouse or child; or the birth, adoption or legal guardianship of a child; or the commencement or termination of your spouse s employment; or a change in employment status from part-time to full-time (or vice versa) by your spouse; or a significant change in your spouse s insurance coverage due to a change in employment status. SUPPLEMENTS TO THE CERTIFICATE Accelerated Benefits Dependents Term Life Portability Benefits F.MHC E

7 Definitions age Attained age as of most recent birthday. application Your application for insurance under the group policy and, if required, your evidence of insurability application. associated company Any company which is a subsidiary or affiliate of the policyholder which is designated by the policyholder and agreed to by us to participate under the group policy. certificate effective date The date your coverage under this certificate becomes effective. contributory insurance Insurance for which you are required to make premium contributions. earnings Your basic rate of compensation not including commissions, overtime or premium pay, bonuses, or any other additional compensation. employee An individual who is employed by the policyholder or by an associated company. A sole proprietor will be considered the employee of the proprietorship. A partner in a partnership will be considered an employee so long as the partner s principal work is the conduct of the partnership s business. The term employee does not include temporary employees nor corporate directors who are not otherwise employees. holidays, weekends and holidays, and approved leaves of absence for non-medical reasons. Non-work day does not include time off for medical leave of absence, temporary layoff, employer suspension of operations in total or in part, strike, and any time off due to sickness or injury including sick days, short-term disability, or long term disability. noncontributory insurance Insurance for which you are not required to make premium contributions. policyholder The owner of the group policy as shown on the specifications page attached to this certificate. specifications page The outline which summarizes your coverage under the policyholder s plan of insurance. waiting period The period, if any, of continuous employment with the employer required prior to becoming eligible for coverage under this certificate. The waiting period is shown on the specifications page attached to this certificate. we, our, us Minnesota Life Insurance Company. you, your, certificate holder An employee who meets the eligibility requirements and becomes insured under the group policy. General Information What is your agreement with us? employer The policyholder or any designated associated companies. evidence of insurability Evidence satisfactory to us of the good health of the prospective insured and any other underwriting information we require. insured A person who is eligible for and becomes insured according to the terms of this certificate. non-work day A day on which you are not regularly scheduled to work, including scheduled time off for vacations, personal You are insured under the group policy shown on the specifications page attached to this certificate. Your application as defined under this certificate is attached and is a part of this certificate. This certificate summarizes the principal provisions of the group policy that affect your life insurance coverage. The provisions summarized in this certificate are subject in every respect to the group policy. Any statements made in your application as defined in this certificate will, in the absence of fraud, be considered representations and not warranties. Also, any statement made will not be used to void your insurance nor defend against a claim unless the statement is contained in the application attached to your certificate. This certificate is issued in consideration of your application and the payment of the required premium. MHC Minnesota Life 2 Ed. F Rev

8 Can this certificate be amended? Yes. We retain the right to amend this certificate at any time without your consent. Any amendment will be without prejudice to any claim incurred for benefits prior to the date of the amendment. Who is eligible for insurance? You are eligible if you: (1) are a member of the group and of an eligible class as defined in the group policy; and (2) work for the employer for at least the number of hours per week shown as the minimum hours per week requirement on the specifications page attached to this certificate; and (3) have satisfied the waiting period as shown on the specifications page attached to this certificate; and (4) meet the actively at work requirement as shown in the section entitled What is the actively at work requirement?. Are retired employees eligible for insurance? If the policyholder s plan of insurance, as reflected in the specifications page attached to this certificate, does not specifically provide insurance for retired employees, a retired employee shall not be eligible to become insured, nor have his or her insurance continued. If the policyholder s plan of insurance specifically provides insurance for retired employees, the minimum hours per week and actively at work requirements will not apply to such persons. What is the actively at work requirement? To be eligible to become insured or to receive an increase in the amount of insurance, you must be actively at work performing your customary duties at the employer s normal place of business, or at other places the employer s business requires you to travel. If you are not actively at work on the date coverage would otherwise begin, or on the date an increase in your amount of insurance would otherwise be effective, you will not be eligible for the coverage or increase until you return to active work. However, if the absence is on a non-work day, coverage will not be delayed provided you were actively at work on the work day immediately preceding the non-work day. Except as otherwise provided for in this certificate, you are eligible to continue to be insured only while you remain actively at work. When will we require evidence of insurability? Evidence of insurability will be required if: (1) the specifications page attached to this certificate states that evidence of insurability is required; or (2) the insurance is contributory and you do not enroll within the enrollment period shown on the specifications page attached to this certificate; or (3) the insurance is noncontributory and you do not become insured, due to nonpayment of premium, within the three-month period beginning on the date you are first eligible for coverage. This will not apply if it is shown that it was due to a clerical error only, in which case premiums will be due retroactive to the date you were first eligible for coverage; or (4) the insurance for which you previously enrolled did not go into effect or was terminated because you failed to make a required premium contribution; or (5) during a previous period of eligibility, you failed to submit evidence of insurability or that which was submitted was not satisfactory to us; or (6) you are insured by an individual policy issued under the terms of the conversion right section. When does insurance become effective? Insurance becomes effective on the date that all of the following conditions have been met: (1) you meet all eligibility requirements; and (2) if required, you apply for the insurance on forms which are approved by us; and (3) we are satisfied with your evidence of insurability, if we require evidence; and (4) we receive the required premium. Can your coverage be continued during sickness, injury, leave of absence or temporary layoff? Yes. The employer may continue your noncontributory insurance or allow you to continue your contributory insurance when you are absent from work due to sickness, injury, leave of absence, or temporary layoff. Continuation of your insurance is subject to certain time limits and conditions as stated in the group policy. If you stop active work for any reason, you should discuss with the employer what arrangements may be made to continue your insurance. Premiums When and how often are your premium contributions due? Unless the policyholder and we have agreed to some other premium payment procedure, any premium contributions you are required to make for contributory insurance are to be paid by you to the policyholder on a monthly basis. We apply premiums consecutively to keep the insurance in force. How is the premium determined? The premium will be the premium rate multiplied by the number of $1,000 units of insurance in force on the date MHC Minnesota Life 3 Ed. F Rev

9 premiums are due. The premium may also be computed by any other method on which the policyholder and we agree. We may change the premium rate: (1) on any premium due date; or (2) anytime, if the policy terms are amended or the total amount of insurance in force changes by 10% or more. Death Benefit What is the amount of the death benefit? The amount of the death benefit is the amount of insurance shown on the specifications page attached to this certificate. Can you request a change in the amount of your contributory insurance? Yes. If the policyholder s plan of insurance, as reflected in the specifications page attached to the group policy, allows for a choice of amounts of insurance for your class, you can request an increase or a decrease in the amount of your contributory insurance within the limitations of the policyholder s plan of insurance, including any limitations on when and how often such requests may be made. All requests must be made in writing. If you request an increase in the amount of your contributory insurance, we will require evidence of insurability. If you request a decrease in the amount of your contributory insurance, we will grant the request. When will changes in your coverage amount be effective? Increases or decreases in the amount of your contributory insurance, if approved, are effective as indicated on the specifications page attached to the certificate. All increases in the amount of insurance are subject to the actively at work requirement. When will the death benefit be payable? We will pay the death benefit upon receipt at our home office of written proof satisfactory to us that you died while insured under this certificate. All payments by us are payable from our home office. To whom will we pay the death benefit? We will pay the death benefit to the beneficiary or beneficiaries. A beneficiary is named by you to receive the death benefit to be paid at your death. You may name one or more beneficiaries. You may also choose to name a beneficiary that you cannot change without the beneficiary s consent. This is called an irrevocable beneficiary. If there is more than one beneficiary, each will receive an equal share, unless you have requested another method in writing. To receive the death benefit, a beneficiary must be living on the date of your death. In the event a beneficiary is not living on the date of your death, that beneficiary s portion of the death benefit shall be equally distributed to the remaining surviving beneficiaries. In the event of the simultaneous deaths of you and a beneficiary, the death benefit will be paid as if you survived the beneficiary. If there is no eligible beneficiary, or if you do not name one, we will pay the death benefit to: (1) your lawful spouse, if living, otherwise; (2) your natural or legally adopted child (children) in equal shares, if living, otherwise; (3) your parents in equal shares, if living, otherwise; (4) the personal representative of your estate. Can you add or change beneficiaries? Yes. You can add or change beneficiaries if all of the following are true: (1) your coverage is in force; and (2) we have written consent of all irrevocable beneficiaries; and (3) you have not assigned the ownership of your insurance. A request to add or change a beneficiary must be made in writing. All requests are subject to our approval. A change will take effect as of the date it is signed, but will not affect any payment we make or action we take before receiving your notice. Termination When does your coverage terminate? The death benefit will be paid in a single sum or by any other method agreeable to us and the beneficiary. We will pay interest on the death benefit from the date of your death until the date of payment. Interest will be at an annual rate determined by us, but never less than 4% per year compounded annually, or the minimum required by state law, whichever is greater. Payment of the death benefit will extinguish our liability under the certificate for which the death benefit has been paid. Your coverage ends on the earliest of the following: (1) the date the group policy ends; or (2) the date you no longer meet the eligibility requirements; or (3) the date the group policy is amended so you are no longer eligible; or (4) 31 days (the grace period) after the due date of any premium contribution which is not paid; or MHC Minnesota Life 4 Ed. F Rev

10 (5) the last day for which premium contributions have been paid following your written request to cease participation under this certificate. If your coverage under the group policy terminates due to non-payment of premiums, your coverage may be reinstated if all premiums due are paid and received by us within 31 days of the date of termination and during your lifetime. Can your insurance be reinstated after termination? Yes. When your coverage terminates because you are no longer eligible, and you become eligible again within three months after the date your coverage under this certificate terminated, your coverage may be reinstated. Provided you are not then covered by an individual policy issued under the terms of the conversion right section, your coverage under the group policy shall be reinstated automatically, without evidence of insurability or satisfaction of any waiting period. Your amount of insurance will be that which applies to the classification to which you then belong, on the date you again become eligible. If the policyholder s plan of insurance provides for contributory insurance under the group policy, your amount of contributory insurance will be limited to that for which you were insured immediately prior to the loss of coverage. When does the group policy terminate? The policyholder may terminate the group policy by giving us 31 days prior written notice. We reserve the right to terminate the group policy on the earliest of the following to occur: (1) 31 days (the grace period) after the due date of any premiums which are not paid; or (2) on any subsequent policy anniversary after the date the number of employees insured is less than any minimum established by us or as required by applicable state law; or (3) 31 days after we provide the policyholder with notice of our intent to terminate the group policy. Conversion Right What is the conversion right? You may convert this insurance to a new individual life insurance policy if all or part of your life insurance under the group policy terminates. You may convert up to the full amount of terminated insurance if termination occurs because you move from one existing eligible class to another, or you are no longer in an eligible class. What is the limited conversion right? Limited conversion is available if, after you have been insured for at least five years, insurance is terminated because: (1) the group policy is terminated; or (2) the group policy is changed to reduce or terminate your insurance. You may convert up to the full amount of terminated insurance, but not more than the maximum. The maximum is the lesser of: (a) $10,000; and (b) the amount of life insurance which terminated minus any amount of group life insurance for which you become eligible under any group policy issued or reinstated by us or any other carrier within 31 days of the date the insurance terminated under the group policy. Neither the conversion right nor the limited conversion right is available if your coverage under the group policy terminates due to failure to make, when due, required premium contributions. Under both the conversion right and the limited conversion right, you may convert your insurance to any type of individual policy of life insurance then customarily issued by us for purposes of conversion, except term insurance. The individual policy will not include any supplemental benefits, including, but not limited to, any disability benefits, accidental death and dismemberment benefits, or accelerated benefits. How do you convert your insurance? You convert your insurance by applying for an individual policy and paying the first premium within 31 days after your group insurance terminates. No evidence of insurability will be required. How is the premium for the individual policy determined? We base the premium for the individual policy on the plan of insurance, your age, and the class of risk to which you belong on the date of the conversion. When is the individual policy effective? The individual policy takes effect 31 days after the group insurance provided under the group policy terminates. What happens if you die during the 31-day period allowed for conversion? If you die during the 31-day period allowed for conversion, we will pay a death benefit regardless of whether or not an application for coverage under an individual policy has been submitted. The death benefit will be the amount of MHC Minnesota Life 5 Ed. F Rev

11 insurance you would have been eligible to convert under the terms of the conversion right section. We will return any premium you paid for an individual policy to your beneficiary named under the group policy. In no event will we be liable under both the group policy and the individual policy. Additional Information What if your age has been misstated? If your age has been misstated, the death benefit payable will be that amount to which you are entitled based on your correct age. A premium adjustment will be made so that the actual premium required at your correct age is paid. Is there a suicide exclusion? The specifications page attached to this certificate indicates what insurance, if any, is subject to the suicide exclusion outlined below. When applicable, this suicide exclusion limits our liability to an amount equal to the premiums paid if you, whether sane or insane, die by suicide within one year of the effective date of your insurance. If there has been an increase in your amount of insurance for which you were required to apply or for which we required evidence of insurability, and if you die by suicide within two years of the effective date of the increase, our liability with respect to that increase will be limited to the premiums paid and attributable to such increase. When does your insurance become incontestable? Except for fraud or the non-payment of premiums, after your insurance has been in force during your lifetime for two years from the effective date of your coverage, we cannot contest your coverage. However, if there has been an increase in the amount of insurance for which you were required to apply or for which we required evidence of insurability, then, to the extent of the increase, any loss which occurs within two years of the effective date of the increase will be contestable. statement you make will not be used to void your insurance, nor defend against a claim, unless the statement is contained in the application attached to your certificate. Can your insurance be assigned? Yes. However, we will not be bound by an assignment of the certificate or of any interest in it unless it is made as a written instrument, and you file the original instrument or a certified copy with us at our home office, and we send you an acknowledged copy. We are not responsible for the validity of any assignment. You are responsible for ensuring that the assignment is legal in your state and that it accomplishes your intended goals. If a claim is based on an assignment, we may require proof of interest of the claimant. A valid assignment will take precedence over any claim of a beneficiary. Is the policyholder required to maintain records? Yes. The policyholder is required to maintain adequate records of any information necessary for us to administer this certificate. We own the records relating to the insurance provided by this certificate, and can obtain them from the policyholder at any reasonable time. If a clerical error is made in keeping records on the insurance under the group policy, it will not affect otherwise valid insurance. A clerical error does not continue insurance which is otherwise stopped. If an error causes a change in premium payment, we will make a fair adjustment. Will the provisions of this certificate conform with state law? Yes. If any provision in this certificate, or in the provisions of the group policy, is in conflict with the laws of the state governing the certificates or the group policy, the provision will be deemed to be amended to conform to such laws. Any statements you make in your application as defined under this certificate will, in the absence of fraud, be considered representations and not warranties. Also, any MHC Minnesota Life 6 Ed. F Rev

12 Accelerated Benefits Certificate Supplement Minnesota Life Insurance Company - A Securian Company 400 Robert Street North St. Paul, Minnesota Benefits received under this Accelerated Benefits Certificate Supplement may be taxable. You should seek assistance from a personal tax advisor prior to requesting an accelerated payment of death benefits. General Information This certificate supplement is subject to every term, condition, exclusion, limitation, and provision of your certificate unless otherwise expressly provided for herein. What does this supplement provide? This supplement provides for the accelerated payment of either the full or a partial amount of an insured s death benefit provided under your certificate. If an insured has a terminal condition as defined in this supplement, you may request an accelerated payment of the applicable death benefit. Definitions accelerated benefit The amount of the death benefit we will pay if the insured is eligible under this supplement. death benefit The amount of the insured s life insurance as shown on the specifications page attached to your certificate. immediate family Your spouse, children, parents, grandparents, grandchildren, brothers and sisters, and their spouses. insured For purposes of this supplement, an insured employee, an insured spouse, or an insured dependent child. physician An individual who is licensed to practice medicine or treat illness in the state in which treatment is received. This does not include you or a member of your immediate family. Terminal Condition What is a terminal condition? A terminal condition is a condition caused by sickness or accident which directly results in a life expectancy of twelve months or less. What evidence do we require of the insured s terminal condition? We must be given evidence that satisfies us that the insured s life expectancy, because of sickness or accident, is twelve months or less. That evidence must include certification by a physician. Do we have the right to obtain independent medical verification? Yes. We retain the right to have the insured medically examined at our own expense to verify the insured s medical condition. We may do this as often as reasonably required while accelerated benefits are being considered or paid. Payment of Accelerated Benefit How do we calculate the accelerated benefit? We will multiply the death benefit by the accelerated benefit factor to determine the accelerated benefit available. How do we calculate the accelerated benefit factor? The accelerated benefit factor will be stated as a percentage of the insured s death benefit. When we calculate this factor, we will consider the insured s age and gender. We will also base our calculation on certain assumptions, which we may change from time to time, including but not limited to assumptions about: (1) expected future premiums; and (2) the insured s life expectancy. What are the conditions for the payment of an accelerated benefit? We will consider the payment of an accelerated benefit, subject to all of the following conditions: (1) coverage must be in force and all premiums due must be fully paid; and (2) application must be made in writing and in a form which is satisfactory to us. We will tell you what form is required; and (3) you must be the sole owner of the certificate; and (4) the insured s insurance must not have an irrevocable beneficiary. MHC Minnesota Life 1 Ed. F

13 Who may request an accelerated payment of the death benefit? You may request an accelerated payment of the insurance on your life or on the life of a spouse or dependent child insured under your certificate. Is the request for an accelerated benefit voluntary? Yes. An accelerated benefit will be made available on a voluntary basis only. An accelerated benefit under this supplement is not intended to cause an involuntary reduction of the death benefit ultimately payable to the named beneficiary. Therefore, payment of the death benefit cannot be accelerated under this supplement if the insured: (1) is required by law to use this option to meet the claims of creditors, whether in bankruptcy or otherwise; or (2) is required by a government agency to use this option in order to apply for, obtain, or keep a government benefit or entitlement. Is there a minimum or maximum death benefit eligible for an accelerated benefit? Yes. The minimum death benefit to be eligible for an accelerated benefit under this supplement is $10,000. The maximum death benefit to be eligible for an accelerated benefit is $1,025,000. Do you have to take the entire accelerated benefit? No. You may choose to receive a partial accelerated benefit. If you do so, the insured s remaining coverage will stay in force. If you elect to receive only a partial accelerated benefit amount available under this supplement, the insured s remaining death benefit under the certificate must be at least $25,000. You may reapply for the payment of the remaining amount of insurance at any time. However, we may ask for further satisfactory evidence that the insured meets all requirements for the accelerated benefit. We reserve the right to charge an additional processing charge. benefits under the certificate and any certificate supplements for that insured will end. If such termination causes a certificate holder s covered spouse or dependent children to lose coverage, each of them will be allowed to convert any such insurance to a policy of individual life insurance according to the conversion right section of the certificate to which this supplement is attached. If a partial accelerated benefit is chosen, coverage will remain in force and premiums will be reduced accordingly. The remaining amount of insurance under your certificate will be the full amount of insurance minus the amount of insurance that was accelerated. How will we pay the accelerated benefit? We will pay the accelerated benefit in one lump sum or in any other mutually agreeable manner. To whom will we pay accelerated benefits? All accelerated benefits will be paid to you unless you validly assign them otherwise. If you die before all payments have been made, we will pay the remainder to the beneficiary named under this certificate. Payment will be made in one lump sum which will be the present value of the payments that remain, using the interest rate we use to determine the payments. Termination When does an insured s coverage under this supplement terminate? An insured s coverage ends on the date the insured is no longer covered for life insurance under the group policy. When does this supplement terminate? This supplement will terminate on the earlier of: (1) the date we receive a written request from the policyholder to cancel the Accelerated Benefits Policy Rider; or (2) the date the group policy is terminated. What is the effect on the insured s coverage of the receipt of an accelerated benefit? If you elect to accelerate the full amount of an insured's death benefit, the insured s coverage and all other Secretary President MHC Minnesota Life 2 Ed. F

14 Dependents Term Life Insurance Certificate Supplement Minnesota Life Insurance Company - A Securian Company 400 Robert Street North St. Paul, Minnesota General Information This certificate supplement is issued in consideration of the required premium and is subject to every term, condition, exclusion, limitation, and provision of your certificate unless otherwise expressly provided for herein. Any Accidental Death and Dismemberment coverage provided by a certificate supplement to your certificate will not apply to dependents coverage provided by this certificate supplement. (4) during a previous period of eligibility, you failed to submit evidence of insurability that was required for a dependent or that which was submitted was not satisfactory to us; or (5) the dependent is insured by an individual policy issued under the terms of the conversion right of this supplement. When does insurance on a dependent become effective? What does this supplement provide? This supplement provides insurance on the lives of your eligible dependents. What members of your family are eligible for insurance under this supplement? The following members of your family are eligible for insurance under this supplement: (1) your lawful spouse in a marriage legal under Indiana law who is not legally separated from you and who is not eligible for insurance as an employee under the group policy; and (2) your children, stepchildren, legally adopted children and children for which you have legal guardianship. Children are eligible from live birth (stillborn and unborn children are not eligible) to the attainment of age 26. If both parents of a child qualify as eligible employees under the group policy, the child shall be considered a dependent of only one parent for purposes of this supplement. If any child qualifies as an eligible employee under the group policy, he or she is not eligible to be insured as a dependent child. Any dependent who, subsequent to the effective date of this supplement, meets the requirements of this provision will become insured on the date he or she so qualifies. When will we require evidence of insurability? Evidence of insurability will be required if: (1) the specifications page attached to your certificate states that evidence of insurability is required; or (2) the insurance is contributory and you do not enroll for coverage under this supplement within the enrollment period shown on the specifications page attached to your certificate; or (3) dependents insurance for which you previously enrolled did not go into effect or was terminated because you failed to make a required premium contribution; or Insurance on a dependent becomes effective on the date when all of the following conditions have been met: (1) the dependent meets all eligibility requirements; and (2) if required, you apply for dependents coverage on forms which are approved by us; and (3) we are satisfied with the dependent s evidence of insurability, if we require evidence; and (4) we receive the required premium. If a dependent is hospitalized or confined because of illness or disease on the date his or her insurance would otherwise become effective, his or her effective date shall be delayed until he or she is released from such hospitalization or confinement. This does not apply to newborn children. However, in no event will insurance on a dependent be effective before your insurance is effective. Death Benefit What is the amount of life insurance on each insured dependent? The amount of life insurance on each insured dependent is shown on the specifications page attached to your certificate. To whom will we pay the death benefit? The death benefit payable under this supplement will be paid to you if living, otherwise to your estate. Termination When does an insured dependent s coverage under this supplement terminate? An insured dependent s coverage ends on the earliest of the following: (1) the date the dependent no longer meets the eligibility requirements; or MHC Minnesota Life 1 Ed. F Rev

15 (2) 31 days (the grace period) after the due date of any premium contribution which is not paid; or (3) the last day for which premium contributions have been made following your written request that insurance on your eligible dependents be terminated; or (4) the date you are no longer covered under the group policy. You must notify us or your employer when a dependent is no longer eligible for coverage under this supplement so that premiums may be discontinued. All premiums paid for dependents who are no longer eligible for coverage under this supplement will be refunded without any payment of claim. When does this supplement terminate? This supplement will terminate on the earlier of: (1) the date we receive a written request from the policyholder to cancel the Dependents Term Life Insurance Policy Rider; or (2) the date the group policy is terminated. Additional Information What is the conversion right under this supplement? Conversion may be requested by you, an insured dependent of legal capacity, or the insured dependent s guardian, if applicable. All other conditions and provisions of the conversion right section of your certificate to which this supplement is attached will apply. Do any Waiver of Premium, Extended Benefits, or Total and Permanent Disability supplements to your certificate apply to insured dependents? Any Waiver of Premium, Extended Benefits, or Total and Permanent Disability supplement to your certificate will not apply to dependents covered under this supplement except as provided for herein. If, due to your disability, your insurance is continued in force without further payment of premiums due to any Waiver of Premium, Extended Benefits, or Total and Permanent Disability supplement to your certificate, any dependents insurance provided by this supplement shall also continue in force without further payment of premiums until the dependent s eligibility terminates or until your insurance is no longer continued in force due to any such supplement to your certificate. This provision is not applicable if the dependent s insurance has been converted under the conversion right section of this supplement, unless the converted policy is surrendered without claim except for refund of premiums. If an insured dependent s coverage under this supplement terminates because he or she is no longer eligible, or because of your death, or because of termination or amendment of this supplement, the insurance may be converted to a policy of individual insurance with Minnesota Life. Secretary President MHC Minnesota Life 2 Ed. F Rev

16 Term Life Insurance Portability Certificate Supplement Minnesota Life Insurance Company - A Securian Company 400 Robert Street North St. Paul, Minnesota General Information This certificate supplement is issued in consideration of the required premium and is subject to every term, condition, exclusion, limitation and provision of your certificate unless otherwise expressly provided for herein. What does this supplement provide? This supplement provides for continuation of your group life insurance if you no longer meet the eligibility requirements of your certificate, except as provided for herein. To continue coverage under the provisions of this supplement, you must make a written request and make the first premium contribution within 31 days after insurance provided by the group policy would otherwise terminate. Evidence of insurability will not be required. Coverage provided by this supplement will then be deemed effective retroactive to the beginning of the 31- day period. This date is considered to be your portability date and you are then considered to have portability status. Who is eligible to continue insurance under this supplement? You are eligible to continue your group life insurance under the terms of this supplement if you, except as provided by this supplement, no longer meet the eligibility requirements of your certificate due to any of the following: (1) you terminate employment, including retirement; or (2) you are no longer in a class eligible for insurance or you are on a leave or layoff; or (3) a class or group of employees insured under the policy is no longer considered eligible and there is no successor plan for that class or group. Successor plan means an insurance policy or policies provided by us or another insurer that replaces insurance provided under this policy. You will not be eligible to request coverage under this supplement if you: (1) have attained the age of 70; or (2) have converted your insurance to an individual life policy under the terms of your certificate s conversion right section; or (3) were not actively at work due to sickness or injury on the date immediately preceding your portability date; or (4) lose eligibility due to termination of the group policy. What insurance can be continued under this supplement? Basic, supplemental and dependent life insurance may be continued under this supplement. You may also continue coverage under all supplements to your certificate by which you were insured immediately preceding your portability date. The amount of insurance continued under this supplement for any individual will be subject to any applicable state law or regulation relating to allowable amounts of insurance. What is the minimum amount of insurance that can be continued under this supplement? The minimum amount of insurance that can be continued on your life under this supplement is $10,000. This minimum does not apply to any other insureds covered under this supplement. What is the maximum amount of insurance that can be continued under this supplement? The maximum amount of insurance that can be continued under this supplement is the amount of insurance that was in force on your portability date, but not more than $500,000 for you or $25,000 for your spouse. However, if you are age 65 or older on your portability date, the amount will not be more than 65% of the amount in force on the insured s portability date to a maximum of $325,000 for you or $16,250 for your spouse. Will the amount of insurance continued under this supplement change? Yes. When an insured attains age 65, the amount of insurance on his or her life continued under this supplement will reduce to 65% of the amount of insurance in force on the day prior to attainment of age 65. Insurance terminates at age 70. Can you request a change in your amount of insurance continued under this supplement? Yes. You may elect to reduce the amount of insurance on your life. Your remaining amount of insurance must be at least $10,000. The amount of insurance continued under this supplement will never increase. MHC Minnesota Life 1 EdF